FREEDOM OF INFORMATION ACT REQUEST

TO: _________________

____________________

FROM: _______________

_____________________

1. This is a request under the Freedom of Information Act, 5 USC 552 and the Privacy Act, 5 USC 552a. I agree to pay costs and fees of locating and copying the documents requested below

2. This request is in the public interest because the requested materials pertain to the public at large and not to any particular person. Also, my funds are limited and I may be a person eligible to receive federal benefits. Therefore, I request that you waive fees and costs, but if you do not, please send the requested materials and do not let the request for waiver delay this FOIA request. You can consider this a firm agreement to pay fees. I request fee waiver because no commercial use is intended and disclosure will contribute to public understanding of the activities of the government.

3. If some of my requests are exempt from release, send me those portions "reasonably segregatable," and provide me with an indexing, itemization and detailed justification concerning information, which you are not releasing.

4. Please send me the following documents:

Date:_____________

Requester________________